Liposomal Bupivacaine Associated with Cost Savings during Postoperative Pain Management in Fragility Intertrochanteric Hip Fractures

Background@#Intertrochanteric hip fractures are among the most common and most expensive diagnoses in the Medicare population. Liposomal bupivacaine is a novel preparation of a commonly used analgesic agent that, when used intraoperatively, decreases narcotic requirements and hospital length of stay and increases the likelihood of discharge to home. The purpose of this investigation was to determine whether there was an economic benefit to utilizing intraoperative liposomal bupivacaine in patients with fragility intertrochanteric hip fractures in comparison to a group of patients who did not receive liposomal bupivacaine. @*Methods@#This is a retrospective observational study performed at two academic medical centers. Fifty-six patients with intertrochanteric hip fractures treated with cephalomedullary nail implant who received standard hip fracture pain management protocol were compared to a cohort of 46 patients with intertrochanteric hip fractures who received additional intraoperative injections of liposomal bupivacaine. All other standards of care were identical. A cost analysis was completed including the cost of liposomal bupivacaine, operating room costs, and discharge destination. Statistical significance was set at p < 0.05. @*Results@#Although the length of hospital stay was similar between the two groups (3.2 days vs. 3.8 days, p = 0.08), patients receiving intraoperative liposomal bupivacaine had a lower likelihood of discharge to a skilled nursing facility (84.8% vs. 96.4%, p = 0.002) and a longer operative time (73.4 minutes vs 67.2 minutes, p = 0.004). The cost-benefit analysis indicated that for an investment of $334.18 in the administration of 266 mg of liposomal bupivacaine, there was a relative saving of $1,323.21 compared to the control group. The benefit-cost ratio was 3.95, indicating a $3.95 benefit for each $1 spent in liposomal bupivacaine. @*Conclusions@#Despite the increased initial cost, intraoperative use of liposomal bupivacaine was found to be a cost-effective intervention due to the higher likelihood of discharge to home during the postoperative management of patients with intertrochanteric hip fractures.

Identification of forming compounds, minimum inhibitory concentration and encapsulation of rosemary officinalis essential oil cultivated in shiraz

Background: Rosemary [Rosmarinus officinalis] is a plant belonging to the mint family that it's antimicrobial, anti-oxidant and anti-mutagenic features caused it to be extensively used in the medical, pharmaceutical and food industries

Objective: In this study, the identification and determination constituents of the essential oil of rosemary and minimum inhibitory concentration of the rosemary essential oil and determine the efficacy of the microencapsulated in chitosan coating was investigated. Methods: To extract the essential oil, water distillation method using clevenger was applied. After forming the oil, compounds were segregated using gas chromatography-mass spectrometry [GC-MS]

The compounds were identified by Kovats index and retention time. In addition to do the encapsulation in chitosane coating emulsification method was applied. To determine the minimum inhibitory concentration of rosemary essential oil, agar dilution method has been applied

Results: The results show that most compounds in rosemary essential oil obtained from the leaves and stem cultivated in the Shiraz and harvested in the month Khordad include: a-Pinene 12.3%, 1,8-CineoIe 12.02% and Camphene 9.2%. Moreover the efficiency of oil extraction and encapsulation were 1.4 % and 39.33% respectively and also the minimum inhibitory concentration of rosemary oil against Slaphylococcus ciureus and Escherichia coli were 8.5 and 3.5 mg/mL

Conclusion: Rosemary has antibacterial and antioxidant features due to existence of some compounds such as a-Pinene and linalool. On the other hand, the efficiency of oil extraction has raised because of the great amount of biologically active compounds and volatile oils

Prevalence and Risk factors of overt- and occult Hepatitis C virus infection among Chronic Kidney Disease patients under regular Hemodialysis in Egypt

Background: hepatitis C virus [HCV] infection is a major health problem. It is more prevalent among chronic kidney disease [CKD] patients. Occult HCV infection, a new, entity has been described

Aims: to find out prevalence of occult HCV infection among CKD patients under regular hemodialysis [RHD] and to define epidemiology of HCV infection among them

Patients and Methods: a sample of 100 CKD patients under RHD was recruited. A questionnaire form was used to collect data. HCV-RNA was tested in serum to detect overt HCV infection patients. HCV-RNA was tested in peripheral blood mononuclear cells of undetected HCV-RNA patients' serum to determine those with occult HCV infection. Rest of the patients was considered HCV free. Biochemical tests were done to all patients

Results: prevalence of overt and occult HCV infection among CKD patients under RHD was 34.0% and 27.3%, respectively. Liver and renal function tests were significantly higher among the overt and occult HCV patients compared to negative HCV patients. Liver function tests were significantly lower among the occult compared to overt HCV patients. Overt HCV patients had significant risk factors compared to negative HCV patients; age group 40-59 years [OR=9.34] and rural residence [OR=3.14]. Also, significant clinical risk factors were the overweight, history of blood transfusion 5>/= times/year, history of nonmedical bloody manipulations, and history of IV drug abuse [OR=3.23, 5.96, 8.28, 7.08, respectively]. Occult HCV patients had significant risk factors compared to negative HCV patients; age group 60 >/= years and rural residence [OR=6.25 and 6.73, respectively]. Significant clinical risk factor was the history of nonmedical bloody manipulations [OR=11.5]

Conclusions and Recommendations: prevalence of overt- and occult HCV infection is high in CKD patients under RHD; this has important clinical and public health implications. There are many significant socio-demographic and clinical risk factors for these infections. A close monitoring of the HD patients and testing them for HCV-RNA in PBMCs yearly to adopted a proper management. Also, more studies on bigger number of patients are required to understand real epidemiology of this health problem

Maternal serum calcium and trace elments; copper and zinc among pre-eclamptic women in Cairo, Egypt

Low levels of blood calcium [Ca] and trace elements are observed in patients with pre-eclampsia [PE]. Among these patients low serum Ca, copper [Cu] and zinc [Zn] may be one of the disease causes. The aim of this study was to find out the serum biochemical profile of these elements in the studied pre-eclamptic women. A case-control, hospital based study design was used. All the cases and controls were examined laboratory. Maternal mean serum Ca, Cu and Zn were lower among pre-eclamptic cases compared to normal pregnant controls with statistically significant differences [P= 0.000 for each of them]. Further, maternal mean serum Ca, Cu and Zn were lower among the severe PE cases compared to the mild cases with statistically significant differences [P-0.002, 0.000 and 0.000, respectively]. Also, these low elements; Ca, Cu and Zn were significantly correlated factors with severe PE [P=0.01, 0.03 and 0.01, respectively]. Early ante-natal care and treatment for pre-eclamptic women are recommended. Ca, Cu and Zn supplementation may be a cost effective method to prevent PE. Prospective population based studies are needed in different areas in Egypt and on large number of pregnant women to determine possible PE risk factors

review on antimicrobial activities of sumac fruit [Rhus Coriaria L.]

Sumac is a shrub with a long history of application in traditional medicine and Iranian cuisine. It grows wild in the region from the Canary Islands over the Mediterranean area to Iran and Afghanistan. The word [sumac] is derived from Aramaic word [sumaqa] which means red. Aside from some studies on sumac as an antioxidant, an anti hyperglycemic, and an anti hyperuricemic agent, many articles have been recently published on antimicrobial activities of sumac because of the advent of new microbial resistances and the need to find new antimicrobial agents. Reviewing the articles suggests that total extracts of sumac fruit have antibacterial activity against both Gram- positive and Gram- negative bacteria but it also shows that sumac fruit has no effect on fungi and anaerobics. More investigation should be conducted on: 1] Fractionization of total extracts and purification of their components to recognize safety use of and ability of sumac as an antimicrobial; 2] Effects of sumac on resistant bacteria and its potential capability as an antimicrobial agent

Preparation and evaluation of killed NDV vaccine using new oil adjuvant

Preparation of inactivated oil Newcastle disease virus [NDV] vaccine using different new oil adjuvant Montonide ISA 70 VG, ISA 763A VG and ISA 775 as oil adjuvants in comparison with paraffin oil was carried out. The prepared vaccines with Montanide ISA 70 VG, 763 A VG and 775 VG induced high antibody titers than that induced by vaccines prepared with paraffin oil when determined by serological tests [HI and SNT]. The highest titer observed in prepared vaccine by ISA 70 VG oil adjuvant after 3 weeks post vaccination and remained high till 12 weeks post vaccination and has long duration of immunity reached to 12 month with a protective antibody titer and protection against challenge while prepared vaccine by Montonide ISA 763 A VG oil adjuvant reached 10 month with Montanide ISA 775 reached to 9 months, but in paraffin protective antibody titer reached only till 5 month

Synthesis and antineoplastic activity of certain triazene and triazeno-acridine combilexin derivatives

Four series of bifunctional ligands have been synthesized as DNA-binding combilexins. These novel agents contain a triazeno-benzene sulfonamide linker moiety that is attached to an intercalating acridine or acridone chromophore by a functionalized amide or ester residue. In order to obtain these combilexins three series of the anticipated antitumor triazeno-benzene sulfonamide were synthesized. The synthesis and bioscreening of the new antineoplastic compounds are depending on the structural correlation with several reported antineoplastic acridines. 2-Chlorobenzoic acid was reacted with anthranilic acid to give N-[2-carboxyphenyl] anthranilic acid which upon cyclodehydration with sulfuric acid afforded 9-oxo-9, 10-dihydroacridine-4-carboxylic acid, [acridone-4-carboxylic acid] 8. This latter intermediate has been converted to 9-chloroacridine carbonyl chloride 9 using thionyl chloride. Selective substitution of 9 with derivatives of 4-[piperazine-l-yldiazenyl] benzenesulfonamides 4a-e or derivatives of 4-[2-hydroxyethyl] piperazine-l-yl]diazenyi] benzenesulfonamides 5a-e to yield their 9-chloroacridine-4-carboxamides 10a-e and 9-chloroacridine-4-carboxylic acid esters 13a-e respectively. Those intermediates have been reacted either with different sulfonamides to give derivatives of 4-[4-[4-[4 sulfamoylphenyldiazenyl] piperazine-l-carbonyl]-9-ylamino] benz-enesulfonamides 11a-h and derivatives of 2-[[4-[4-sulfamoyl-phenyl]diazenyl]piperazine-l-yl]ethyl 9-[4-sulfamoylphenyl-amino]-9,10-dihydroacridine-4-carboxylates 14a-i respectively or subjected to mild acid hydrolysis to yield derivatives of 4-[4-[[9-oxo-9,1 Q-dihydroacridine-4-carbonyl]piperazine-l-yl]diazenyl]-benzenesulfonamide 12a-e and derivatives of 2-[4-[[4-sulfamoyl-phenyl]diazenyl]piperazine-l-yl]ethyl-9-oxo-9,10-dihydroacridine-4-carboxylate 15a-e respectively. Besides, the synthesis of derivatives of 4-[piperazine-l-yldiazenyl] benzenesulfonamides 4a-e and derivatives of 4-[2-hydroxyethyl]piperazine-1-yl] diazenyl] benzenesulfonamides 5a-e has been achieved via diazotization of various substituted benzene sulfonamides with sodium nitrite and hydrochloric acid followed by various amines coupling to yield the target triazeno-benzene sulfonamides. Fourteen new compounds were selected for screening their antitumor activity against breast cell line in National Cancer Institute. Six of them were found to be active as antitumor agents, while two were found to be mild active

Design and synthesis of some substituted acridine derivatives of anticipated antitumor activity

Four series of new acridine derivatives of anticipated antitumor activity have been designed and synthesized. The first series belongs to 4-substituted phenylhydrazinocarbonylmethyl 9-oxo-9,10-dihydroacridine-4-carboxylate 10a-h. The second series consists of phenylhydrazinocarbonylmethyl 9-[4-substituted phenyl]aminoacridine-4-carboxylate 12a-k, while the third series comprises 4-substituted phenylcarbonylmethyl 9-[4-substituted phenyl]aminoacridine-4-carboxylate 15a-k. The fourth one belongs to phenylcarbamoylmethyl 9-[4-substituted phenyl]aminoacridine-4- carboxylate 17a-j. The chemical structure of synthesized compounds was elucidated by spectral data and elemental analysis. Seventeen selected compounds [10a, 10g, 10h, 12at 12d, 12g, 12h, 12k, 15a, 15c, 15g, 15h, 15k, 17a, 17f, 17g and 17j] were tested against breast cancer cell line [MCF7] and eight compounds [12g, 12h, 12k, 15g, 15h, 17f, 17g, 17j] were found to exhibit significant antitumor activity

Study on microscopical characteristic and composition of the volatile oil of fruit of petroselinum hortense hoffm

Parsley [Petroselinum hortense Hoffm.] is one of the most famous medical and nutritional herb. Fruits of parsley traditionally used as diuretic, appetizer, vasodilator, with out any side effects. Also, it is used in cosmetic industry as a deodorant to cure halitosis and in nutritional industry. Study of microscopical characteristic, extraction and identification of the essential oil of the chemical composition of Parsley seed, is the main aims of this study. For this research, fruits have seen purchased from the market of Tehran and Identified. Microscopical characteristic will be done using light microscope and extraction of the essential oil will be done with hydro-distillation method using Clevenger apparatus and then identified after GC/MS findings. Endosperm containing crystals of calcium oxalate and oil spots, parts of compact cells of Endocarp, a group of fibro vascular, Epiderm tissue containing fragment of a vitta, were the most fragments of the powdered seed. The total amount of the Essential oil was 1% V/W and the most analyzed compounds were: 1,8 cineol [59.2%]-alpha- phellandren [18.6%]-alpha-pinene [7.6%]. There was no difference between the microscopical characters of the powdered seeds of Iranian cultivated Parsley with the cultivated specimen in other country. The absence of two compounds; Apiol [aborticide agent] and Miristicin [agent causing euphoria] in Iranian cultivated Parsley is a significant safe character for the using of the Iranian specimen in food and pharmaceutical industries

Immunocapture RT-PCR detection and partial nucleotide sequence of the coat protein gene of citrus psorosis virus from Egypt

Citrus psorosis virus [CPsV] is a multipartite virus with ssRNA genome present in very low concentration in infected citrus tissues. Diagnosis is made by biological indexing an indicator trus seedling but it is time consuming and expensive procedure; therefore it is not used generally. Direct tissue blot immunoassay [DTBIA] technique which requires very little sample manipulation, has been used for rapid detection of CPsV proved to be more sensitive and cheaper than ELISA. Attemptes for the detection of CPsV by DTBIA technique using flower explant tissues from CPsV infected isolates with a conjugate CPsV polyclonal antibody showed high signals especially with the ovary referring to the high titre of the virus in the ovary. A high reliable sensitive immunocapture reverse transcription-polymerase chain reaction [IC-RT-PCR] assay followed by nested-PCR was developed for the detection of CPsV. Two sets of primers were used to amplify the all length coat protein ORF [1365 bp] and a core region of 600 bp of the viral coat protein. The 600 bp core-CP fragment from the isolate, CPsVE1, was cloned and sequenced. The sequence Comparative analysis of nucleotides showed 98% similarity with CPV4 and CPV-4e isolates belonging to Argentina and Florida, respectively. Therefore, the CPVE1 isolate is probably considered the type strain of CPV especially citrus ring spot virus

Milk thistle and cancer

Milk thistle [Silybum marianum [L] Gaertn] is endemic of several European, African and Asian country like Iran. Althuogh literature on its uses in Iranian traditional medicine is not published, but is used extensively in some European country. Several clinical and experimental study undertaken to investigate efficacy of milk thistle seed extract [Silymarin] in several chronic disease. Silymarin contain several compound like flavonoid with antioxidative property and scavengering free radical. Free radicals are by-product of abnormal body metabolism in several chronic diseases and are important factor for late complication and secondary disease. Here in this article the published data on silymarin its effect on oxidative stress and cancer are reviewed

IgG isotypes in Schistosomiasis patients before and after praziquantel

This work evaluated circulating anti-SWAP IgG1 and IgG4 in patients with active S. Mansoni infection before and after PZQ and its correlation to clinical, laboratory and sonographic data. The main complaints were abdominal discomfort, pain, tensmus and bleeding per rectum, which decreased progressively after PZQ. The results indicated that anti-SWAP IgG1 and IgG4 were significantly higher in patients than controls. The results also showed a progressive significant decrease in the level of circulating anti-SWAP IgG1 after treatment, a decrease of IgG4 three months after treatment and a decrease in the egg count after therapy. But, no significant difference in IgG1 or IgG4 was noticed between male and female patients before and after treatment. There was no significant difference in IgG1 or IgG4 in patients having GIT manifestation and organomegalic patients and/or asymptomatic patients. Also, there was no significant difference in IgG1 or IgG4 between patients with grade 0, grade I and grade II periportal fibrosis. The sensitivity of ELISA IgG1 was 73.3% and specificity was 80%, while of ELISA IgG4 was 80%. Enlarged liver and/or spleen, periportal fibrosis and dilated PV detected by ultrasonography were more among patients than controls. There was no significant difference in hematological parameters and liver function tests between patients and control groups. The study showed that ELISA is sensitive and specific for IgG1 and IgG4. Anti- SWAP IgG1 and IgG4 are useful means in diagnosis and cure and consider as parameters for evaluating cure. Follow up of anti-schistosomal IgG1 and IgG4 is useful for assessment of treatment

Evaluation of selective oestrogen receptor modulators [raloxifene] on bone mineral density, serum lipids and uterine endometrium in early postmenopausal women

This study was to evaluate the effect of the second generation selective oestrogen receptor modulator [SERMs], raloxifene, on bone mineral density, serum lipid concentrations, and endometrial thickness in 100 postmenopausal women. The women were divided into two equal groups of 50 women each, and were randomly assigned to receive 60 mg of raloxifene or placebo daily for 24 months. This study revealed that women receiving [SERMs], raloxifene had significant increases from base-line values in bone mineral density of the lumbar spine, hip, and. total body, whereas those receiving placebo had decreases in bone mineral density. Serum concentrations of total cholesterol and low-density lipoprotein cholesterol decreased in the raloxifene group, whereas serum concentrations of high-density lipoprotein cholesterol and triglycerides did not change. Endometrial thickness were comparable in the raloxifene and placebo groups at all times during the study. The proportion of women receiving raloxifene who reported hot flashes or vaginal bleeding were not different from that in women receiving placebo. Selective oestrogen receptor modulator [SERMs] Raloxifen at a dose 60mg per/day increases bone mineral density, lowers serum concentration of total and low-density lipoprotein cholesterol, while has no effect on the endometrium or the breast

Studies of wound myiasis among sheep and goats in north Sinai governorate, Egypt

Studies of myiasis of sheep and goats in North Sinai resulted in the identification of 21 species of myiasis producing flies. The predominant species was Musca domestica, followed by Lucilia sericata and the least abundant was M. albina. In general, sheep were more infested with wound myiasis than goats. The overall infestation rate was high in summer, followed by spring then autumn. The least rate of infestation was winter. As to the different areas examined, the high rate of infestation was in Bir-Al-Abd, followed by El-Hasanah, El- Arish, El-Sheikh Zowaid and, lastly, Rafah. The factors predisposing to wound myiasis in a descending order of importance in goats were open wound, shearing wound, caseous lymphadenitis, foot rot, fecal staining, ophthalmo or facial eczema, horn fracture, rumen fistula and, lastly, posterior paralysis. In sheep, the most important cause was caseous lymphadenitis, followed by foot rot, then open wound and fecal staining, shearing wound and ophthalmo or facial eczema, otherwise more or less the same as in goats

Primary extranodal lymphoma of the mandible and maxilla

12 cases with maxillary and mandibular manifestations of non Hodgkin's lymphoma have been studied with reference to age, sex, location of the lesion and the histologic type. There were 3 children ranging in age from 2 to 5 years and 9 adults ranging from 20 to 75 years. There is a male preponderance M/F ratio 10/2. All cases examined were of B cell origin. Different histological patterns were detected 4 cases [33.4%] showed Burkitt's Lymphoma, 3 cases [25%] showed small lymphocytic lymphoma and [25%] showed mixed cell pattern. 2 cases [16.6%] showed large cell type. No cases of Hodgkin's lymphoma nor nodular type of non Hodgkin's lymphoma were detected

Porous hydroxyapatite blocks and ceramic as a bone substitute in bone defects

Porous hydroxyapatite blocks and ceramic were used to obliterate induced bone cavities in the femur of rats. The study demonstrated that PHA blocks give much better results than cermic material when used as a bone substiture

Effect of soft laser on healing of tongue wounds

In the present study the effect of soft laser on healing of intra oral inflicted wounds on the dorsal surface of the tongue in albino rats was investigated. The lased tissues exhibited enhanced healing evidenced by more collagen formation than in the control animals which denotes that soft laser has significant effect on wound healing

Porous hydroxyapatite blocks and granules in bony defects in rats

The use of porous hydroxyapatite granules and blocks in obliteration of induced bony defects in rats showed superior results in case of the use of PHA granules in comparison with the results in case of the use of PHA blocks